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The draft Sexual Health and Relationships Strategy for Scotland: Its development, key recommendations and lessons learnt Shirley Fraser Sexual Health & Wellbeing Learning Network Co-ordinator. The state of sexual health in Scotland. One in four young people sexually active before age 16

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The draft Sexual Health and Relationships Strategy for Scotland: Its development, key recommendations and lessons learntShirley FraserSexual Health & Wellbeing Learning Network Co-ordinator

the state of sexual health in scotland
The state of sexual health in Scotland
  • One in four young people sexually active before age 16
  • Pregnancies in under 16s falling
  • Majority of STIs have no symptoms therefore remain undiagnosed/untreated - chlamydia on significant increase
  • HIV still a major concern but not a recognised risk
  • 1 in 10 women experience sexual assault
  • Social disadvantage is strongly linked to poor sexual health
the state of sexual wellbeing in scotland
The state of sexual wellbeing in Scotland
  • Many young people regret early sexual experience
  • Having more than one sexual partner at the same time is becoming more common
  • Less than half of parents talk to their children about sex and sexual health – no consistent approach to sex and relationships education
  • Alcohol and drugs influence sexual behaviour in all age groups

To draw up a sexual health strategy for Scotland with particular reference to measures:

  • To reduce unintended pregnancy and STIs
  • To enhance the provision of sexual health services
  • To promote a broad understanding of sexual health and sexual relationships that encompass emotions, attitudes and social context.

Developing the Sexual Health and Relationships Strategy

Engagement Exercise


Reviews (Cochrane, Campbell, H.D.A)

Literature searches (Medline, Embase, CINAHL)

Project literature (Learning network information, Healthy Respect demonstration project, commissioned research)

Expert opinion and current practice (reference group and their networks, Health Scotland, professional networks)

Comparison (local strategies, other countries’ strategies)


Briefing papers

Reference Group

Project Team

Draft strategy and background papers

Final strategy and background papers

Submission to Scottish Executive

Consultation on proposals


A society that accepts sex as a normal and healthy aspect of life, in which people understand the value of their own sexual health, the importance of responsibility and respect for others and have the capacity and means to protect themselves from unwanted outcomes of sexual activity.

overarching aims
Overarching Aims
  • To influence the cultural and social factors that impact on sexual health
  • To support everyone in Scotland to acquire and maintain the knowledge, skills and values necessary for sexual wellbeing
  • To improve the quality, range, consistency, accessibility and integration of sexual health services.
key actions
Key Actions
  • Providing national and local leadership
  • Setting clear national and local targets and goals
  • Using existing mechanisms
  • Monitoring progress to ensure delivery
promoting positive sexual health
Promoting positive sexual health

Through reducing:

  • individual barriers to empowerment & choice
  • Physical barriers to service use
  • Social barriers to services and knowledge
  • Cultural barriers at a societal and service level
By addressing:
  • Lifelong learning
    • Schools/community
      • Consistent approach to sex and relationships education/Implementation of McCabe Report
      • Supporting teachers
      • Closer links between schools and services
    • Parents and carers
      • Through information and communication skills
    • Adults
      • Through workplace and leisure
      • Mass communications/media
By addressing:

Services through

  • An integrated tiered approach
  • Supporting access & reaching those in need of services
  • Targets and standards
service values principles
Service values & principles
  • Be sensitive, respectful, confidential, user friendly and culturally competent
  • Be provided in high quality accessible premises
  • Adopt a non judgemental approach to sexuality and sexual orientation
  • Actively involve users in service planning and implementation
  • Offer support/information to enable informed choices and fulfilling/healthy relationships
  • Have appropriately trained staff supported by appropriate resources
integrated tiered approach
Integrated tiered approach
  • Tier 1: Self management
  • Tier 2: Individualised information with some intervention
  • Tier 3: Community based services
  • Tier 4: Enhanced services
  • Tier 5: Specialist services
characteristics of tiered approach
Characteristics of tiered approach
  • Help provide a more flexible approach to service delivery
  • Represent a continuum in care: individuals may move through tiers for care or stay at one tier for all care
  • Choice of at least two providers for each tier
  • Allow staff in any setting to provide services from range of tiers
supporting service access
Supporting service access


  • Reducing barriers
  • More flexible roles
  • Better information
  • Maintaining confidentiality and anonymity
  • Improving infection control
targets and standards
Targets and standards

In relation to:

  • Identifying and treating sexually transmitted infections
  • Access to termination services and sexual dysfunction services
  • Access to specialist services within 48 hours
Supporting Framework
  • Leadership and accountability:
    • National
      • Advisory Committee/Co-ordinator
    • Local
      • Inter agency strategy group
      • Lead Clinician
      • Managed Network/Co-ordinator
      • LA designated lead/school lead
      • CHP/locality lead
what does the strategy mean for
What does the Strategy mean for


  • A supportive environment for the positive promotion of sexual wellbeing
  • A culture of “Healthy Respect”
  • Reductions in sexual ill health
  • A multi-layered response including lifelong learning and services to enhance sexual health improvement
an integrated response to sexual health and wellbeing in scotland
An integrated response to sexual health and wellbeing in Scotland







consultation process and beyond
Consultation Process and beyond
  • Formally issued for consultation – 14/11/03
  • Series of formal and informal consultation events
  • Online submissions
  • Parliamentary debate
  • Targeted response uptake
  • Close of consultation – 27/02/04 extended to 15/03/04 – 1500 submissions to date
  • Analysis begins………………….final strategy launched winter 2004?
lessons learnt 1
Lessons Learnt (1)
  • Need consensus from outset regarding scope, remit, timescale and ownership
  • Over focus on sexual ill health rather than positive sexual wellbeing
  • Multi agency, multi professional approach important – led by unbiased “champion”
  • Listening to all interests but balancing disparity of views
lessons learnt 2
Lessons learnt (2)
  • Long way to go before evidence based policy and practice natural starting point for strategy development
  • Little evidence on what works beyond young people and specific sub populations
  • Tackling the Scottish psyche and culture
Shirley Fraser

Sexual Health & Wellbeing Learning

Network Co-ordinator

Health Scotland, Clifton House, Clifton Place,

Glasgow G3 7 LS

  • Tel: 0141 300 1047
  • Email: